Episiotomy Care and Recovery: A Gentle Guide for New Mothers

In short: The episiotomy wound after a vaginal birth usually heals fully by the end of the postnatal period. To care for it: wash the area daily with water, change pads regularly, drink at least two litres of water a day, avoid heavy lifting for 4–6 weeks and start pelvic floor exercises early. See the doctor for foul-smelling discharge, fever, redness, bleeding from the stitches or opening of the wound.

An episiotomy is a small cut made in the perineum during vaginal delivery to widen the vaginal opening when the baby needs to be born more quickly or with the help of forceps or vacuum.

An episiotomy is not done routinely. It is used only when there is a clear reason, such as when the baby needs to be born quickly or an assisted delivery (forceps or vacuum) is needed. It is more often needed by first-time mothers, but the decision always depends on the individual case and the doctor’s assessment.

What is a perineal tear?

(The perineum is the area between the vaginal opening and the anus.)

A perineal tear that affects only the skin is called a first-degree tear and usually heals naturally on its own. If the tear reaches the muscles, it becomes a second-degree tear and requires stitches. If it extends to the muscle that controls the anus, it is a third-degree tear. If it reaches the lining of the anus or rectum, it becomes a fourth-degree tear.

A third- or fourth-degree tear is one where the tear in the perineum extends all the way to the anus.

What can be done to speed up recovery?

• Keep the perineal area clean by washing it daily with water and changing sanitary pads regularly. Wash your hands before and after using the toilet to reduce the risk of infection of the stitches.
• Drink plenty of fluids to avoid constipation; aim for at least two liters of water daily. Maintain a balanced diet (vegetables, fruits, grains, and whole-wheat bread).
• Start gentle pelvic floor exercises as soon as possible after giving birth.
• Avoid strenuous exercise and lifting heavy objects for at least 4-6 weeks.
• Take the pain medication prescribed by your doctor

A cold pack wrapped in a cloth for 10–20 minutes, and paracetamol or ibuprofen (both safe while breastfeeding), can ease the pain. Most stitches dissolve on their own, and the wound usually heals within 2–4 weeks..

• Antibiotics are not routinely needed after an episiotomy or a simple tear. They are given if you had a third- or fourth-degree tear, or if signs of infection appear; if your doctor has prescribed them, complete the full course.
• Consult a doctor immediately if you notice any of the following signs: foul-smelling discharge, fever, chills, redness in the area, bleeding from the stitch site, or wound separation.

Healing after an episiotomy takes patience, and every new mother’s recovery is a little different. If you have concerns about your stitches, pain, or healing progress, don’t hesitate to reach out to Dr. Najeeb Layyous and his team for supportive, personalized guidance during your postpartum recovery.

Dr Najeeb Layyous F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist